Up to 9 million beneficiaries (half of them children) now could face such new costs. Although beneficiaries with disabilities and those who are dually eligible for Medicare and Medicaid are exempt, the legislation also allows states to offer alternatives to the traditional Medicaid coverage that may have less extensive rehabilitation benefits. Concerns about this legislation are discussed further below.

To various degrees, depending on an individual’s age, place of residence, type of disability, and other characteristics, people who need assistive technologies or services may find noninsurance programs helpful. Some of these programs are privately sponsored. Others are funded by federal or state governments.

For children, the Individuals with Disabilities Education Act (IDEA), as amended, includes important provisions related to assistive technology (Hager and Smith, 2003). In essence, IDEA requires that if states and school districts accept federal education funds, they must make available to children with disabilities a free, appropriate public education, including special education and related services that allow a child to benefit from such education (see Chapter 4). Each child is to have an individual education program or plan that identifies the services that need to be provided without charge, as determined on a case-by-case basis. Covered devices (e.g., specially adapted laptop computers) may sometimes be used at home as well as at school if that is educationally necessary. The school district often retains ownership of assistive devices that have not been personally prescribed, which means that a young person may lose access to the technology once he or she graduates from high school. The “related services” provision of IDEA also extends to personal care services. In 2004, more than 6.8 million children ages 3 to 21 received services under IDEA (U.S. Department of Education, 2005).

The federal Assistive Technology Act does not directly fund the provision of equipment but, rather, supports technology development, training for rehabilitation engineers and technicians, technical assistance and advocacy, and research on needs for assistive technology. In addition, it requires states that receive grants under the act (as all states do) support awareness programs, provide outreach, provide loans, and engage in certain other activities to promote assistive technologies.

Other programs, including Vocational Rehabilitation programs, may also provide access to assistive technologies, as summarized in Table 9-2. These programs generally do not have assistive technology as their primary focus (Freiman et al., 2006). In addition to the programs listed, state work-

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